Coolsculpt Cryolipolysis (Freezing Fat) Can Make You Fatter

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Studies freezing fat in order to remove it without surgery were first done in 2008. Since then Cryolipolysis has become the most popular noninvasive fat reduction procedure in the world. Cryolipolysis involves the noninvasive cooling of fat to selectively kill fat cells without injuring surrounding non-fat tissue. These cells slowly dissolve and gradually release the fat contained within them. It takes 2-4 months for this process to reduce the fat layer and the results of a cryolipolysis treatment become visible. A just published review of patients undergoing the procedure between 2013 and 2016 revealed that as many as 1 out of every 138 cryolipolysis treatments has the opposite effect. Those patients develop paradoxical adipose hyperplasia (PAH) i.e. the fat in the treated area grows larger becoming noticeable up to 3 months following the treatment. There have been no described cases of this resolving on its own.

The combination of suction and cold in #coolsculpting initiates an inflammatory response in some individuals most likely in response to dying fat cells resulting in enlargement and/or proliferation of the adjacent fat cells. It is currently unclear if this is mostly due to machine settings, genetic predisposition or technical aspects of the treatment. While inflamed the pinched fat feels hard and may be tender to pinch. It takes 6 to 9 months after the initial coolsculpting treatment for the inflammation to resolve and the fat to soften on pinch. The treatment for PAH is standard surgical liposuction but if the surgery is performed before the fat softens/inflammation resolves it will only stimulate the fat to grow even more. Unfortunately more than 1 liposuction treatment may be required, liposuction that employs heat (laser assisted liposuction, Vaser...) compound the problem and

paradoxical adipose hyperplasia after coolsculpting that has stretched the skin

if this occurs on the abdomen it can stretch the skin turning a patient for whom liposuction would have been sufficient before coolsculpting to someone who requires an abdominoplasty/tummy tuck after coolsculpting.

The incidence of PAH after coosculpting is high enough that it should be on the consent forms for the treatments to meet the definition of informed consent for the treatments.

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Liposuction and its variants tumescent liposuction, superficial liposuction, smartlipo, power assisted liposuction, microliposculpture, smartlipo
Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Armpit Rolls and Tail of the Breast

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Armpit Rolls

Armpit rolls are folds of skin and fat that lie at the upper front edge of the armpit. They make some women self conscious about wearing spaghetti strap tops or strapless dresses and bras. Their presence can be independent of breast size or patient weight

Armpit Rolls Are Independent of Breast Size as Seen Before and After Breast Reduction Surgery

Improving Calf Definition by Calf Implant Surgery or Fat Grafting

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In a woman the maximal circumference of an aesthetically pleasing leg should be less than one-fifth of her body height and the ideal aesthetic contour of the leg has been defined as relatively flat in the medial upper third of the calf, with a gradual tapering to the ankle. Calf asymmetry is defined as a difference in the maximal circumference greater than 2.0 cm between both calves when standing on tip toes. Asymmetry can be due to surgery, sports activities, nerve injury or obesity. Bodybuilders want larger more well defined calf muscles and most women want slender longer looking legs, especially if they are shorter in height.

Lipedema, Lymphedema and Fat Legs

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The 4 main causes for enlarging leg girth or circumference are lipedema (accumulation of fat in the legs), lymphedema (obstruction of lymph flow in the leg), obesity and impaired venous blood circulation (venous stasis). Lymphedema is observed as swelling that usually involves the feet and shows up as impaired flow on lymphangiograms or lymphoscintigraphy . With time the swelling becomes hard and uncompressible and the skin breaks down and becomes infected. Impaired venous circulation is observed as swelling with brown darkening of the skin color, skin break down and inflammation. The blocked veins are visualized by doppler sonography studies using sound waves transmitted through the skin. This blog will focus on lipedema also known as lipoedema in Europe.

The areas of fat concentration tend to be abdominal in aging men, hips and thighs in aging women and buttocks in certain races as those individuals age. The age at which this occurs varies from person to person. Changes in metabolism and fat deposition can also occur more quickly at puberty, after childbirth, gynecologic surgery, with the onset of thyroid disease or menopause. It is easier to lose fat from areas in which your body tends to not concentrate fat. The fat doesn't go to one place and then another as in first, second etc.. It goes all over but more of it is stored in specific areas and it is mobilized from other areas more easily. In some cases the concentration can be dramatic such as very large buttocks with skinny arms and legs, steatopygia, which is more common in certain African tribes.

Liposuction Can Result in More Fat Around Internal Organs

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Plastic Surgeon researchers at the University of Sao Paulo in Brazil followed 36 normal-weight women who had liposuction to take away a small amount of superficial tummy fat. Beginning 2 months after surgery half of these women were placed on an exercise program (walking on a treadmill and doing light strength training 3 times a week), while the rest stuck with their usual lifestyle. None exercised regularly before surgery.

Four months later the women who did not exercise still had flatter tummies, but they had 10% more fat around the organs inside the abdomen. The women who did exercise had no such gain in this visceral fat. This the the first study showing increases in visceral fat after liposuction if you do not exercise.

Cellulite - Cottage Cheese Thighs

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Cellulite (Gynoid lipodystrophy in medical jargon) is the only word we have to describe the uneven pitted surface or dimpling of the skin commonly seen on the thighs of women. The appearance often is described to resemble the surface of an orange peel or that of cottage cheese. The term cellulite was first used by Alquin and Pavot in France to describe this condition. It is common in women, rarely seen in men and begins at various ages depending on body habitus, genetic makeup, etc. Most middle aged women have it. The remainder thinks they have it. As sure as a woman will grow breasts after puberty, she will get dimples and lumps on her skin. Cellulite affects only the buttocks, thighs and legs to about four inches above the knees. I see many patients requesting correction of their cellulite and an equal number of proposed treatments. These include aminophylline wraps, liposuction, liposuction with forked metal tubes to cut fascial strands to the skin and combinations of liposuction with lasers. None are truly effective.

Abdominoplasty, thigh buttock lift and belt lipectomy

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Abdominoplasty - Tummy Tuck


Thigh Buttock Lift - Belt Lipectomy (mostly for patients after massive weight loss or bariatric surgery, gastric bypass etc.)


Abdominoplasty for excess skin and fat and loose muscle
Abdominoplasty for excess skin
Abdominoplasty after weight loss
Belt lipectomy 1
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Aaron Stone MD - Plastic Surgeon Los Angeles
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Liposuction and its variants tumescent liposuction, superficial liposuction, smartlipo, power assisted liposuction, microliposculpture, smartlipo

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Liposuction and all its variants tumescent liposuction, large volume liposuction, superficial liposuction, smartlipo, slimlipo, power assisted liposuction, microliposculpture, ultrasound assisted liposuction, superwet liposuction, xerona, Syringe-Assisted Liposuction, liposuction using a laser, water jet assisted liposuction.

Liposuction was first introduced in France in 1977. The technique involved the injection of diluted salt water to break the fat cells followed by stab incisions in less noticeable areas such as the belly button through which hollow metal tubes were inserted to suck out fat under general anesthesia. This was later referred to as dry liposuction because so little fluid was injected. This was temporarily modified in the early 1980s using metal tubes with recessed blades to cut the fat. This did not last as blood vessels and nerves were damaged in the process. The use of the dry technique with either type of metal tube was associated with a high percentage of blood coming out of the tube. This limited the amount of fat that could safely be removed at one time.

Mesotherapy, Lipo-Dissolve, or Injection Lipolysis, Lipozap, Kybella

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Mesotherapy involves the injection of medications under the skin. It has been widely used in Europe for years to treat cellulite, psoriasis or spot reduce fat, amid unsubstantiated claims. One subset of this treatment modality is injection lipolysis where a mixture of phosphatidylcholine(lecithin), isoproterenol, deoxycholate, blood vessel dilators, nonsteroidal anti-inflammatory agents, enzymes (such as collagenase or hyaluronidase), aminophylline, caffeine, L-carnitine, buflomedil, calcitonin, vitamins, minerals and hormones in varying combinations are injected into the fat layer under the skin to destroy fat cells. Some of these medications stimulate fat cells to break apart fat molecules contained in the cells. However fat cells in some areas like the thighs and hips are more resistant to this stimulation. The true mechanism of action of some of the medications remains unknown. Multiple injections are made into the treated area per session and sessions are performed a few weeks apart. Some or all of the injected medications are frequently not FDA approved for injection.